title: Topical Cyclosporin A in the treatment of acute graft  rejection: a randomized controlled trial.
abstract: BACKGROUND
  Corneal graft rejection is the commonest cause of graft failure. Currently, intensive topical steroid is the treatment for graft rejection.We hypothesized that the use of topical Cyclosporin A (CsA) 0.05%, specifically Restasis (Allergan) in addition to intensive steroids would aid in the reversal and treatment of endothelial graft rejection.
  
  
  METHODS
  In a randomized double masked control study, we recruited 108 patients with acute endothelial graft rejection. They were randomized to two groups. The first group received intensive prednisolone acetate and placebo. The second group received intensive prednisolone acetate and Restasis.
  
  
  RESULTS
  There was no difference between the baseline characteristics for the two groups. Nine out of 54 in the placebo group and five out of 54 (16.7% vs. 9.2% P = 0.23) in the treatment group were exited from the study because of worsening signs despite treatment. No significant difference was found between the two groups for time to reversal and resolution. Side-effects of the treatment include increased intraocular pressure and punctate epithelial erosions.These changes most likely relate to the use of intensive prednisolone acetate.
  
  
  CONCLUSIONS
  The use of commercially available CsA as an adjunct to topical steroids does not appear to improve the outcome of graft rejection.
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Corneal Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia. alexpoon@ozemail.com.au
authors.forename: Alexander
authors.initials: A
authors.lastname: Poon
authors.forename: Marios
authors.initials: M
authors.lastname: Constantinou
authors.forename: Ecosse
authors.initials: E
authors.lastname: Lamoureux
authors.forename: Hugh R
authors.initials: HR
authors.lastname: Taylor
mesh_terms: D000208:Acute Disease; D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016039:Corneal Transplantation; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D019573:Epithelium, Corneal / Q000187:drug effects / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007429:Intraocular Pressure / Q000187:drug effects; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; C009935:prednisolone acetate; D011239:Prednisolone